Multiple TAL case managers appear to have instructed private investigators to attend hospitals and police stations under false pretences to gather information that would enable the insurer to deny claims, the Royal Commission into Misconduct in the Banking and Financial Services Industry was told on Thursday.
Citing email correspondence between a TAL case manager and an investigator, senior counsel assisting the Commission, Rowena Orr QC, inferred that investigators were encouraged to conduct “pretexts,” which appeared to involve posing as relatives of claimants in order to gather information that could possibly result in the denial of their claims.
The correspondence read: “Please complete a pretext at the hospital (where the insured worked) and maybe discuss with the local police about her (the insured). There may be some issues there as well.”
Senior Counsel Orr asked Loraine van Eeden, general manager, claims at TAL Group: “What did it mean to do a ‘pretext’ at the hospital?”
“Once again, I’ve got no idea,” van Eeden replied.
Orr continued: “The private investigator was being asked to go to the hospital and under some pretext seek information about the insured, wasn’t he? Perhaps posing as a family member or a friend … Would it be appropriate to do that, to instruct that to happen?”
“No,” van Eeden responded.
Orr continued: “What about to instruct the private investigator to go to the local police station and see if they had any information about the insured?”
“This is all inappropriate,” van Eeden said.
Orr said this behaviour was inappropriate and was the result of the decisions of multiple TAL case managers – not just one person, which van Eeden agreed was the case.
Referring to other correspondence, Orr also told van Eeden it was pretty clear what a case manager meant when they told an investigator that they “want results”.
“She wanted the investigator to find information that would provide a basis for TAL to cease paying the insured’s claim, a basis for TAL to avoid paying the $792,000 liability that it would have under this policy.”
Van Eeden acknowledged her previous statement furnished to the Commission that the approach taken by TAL to seek to avoid paying the claim was “absolutely contrary to the way a claim should be handled” and that the direction given in the email, the tone of the email and the instructions given to the private investigator was “totally unprofessional”.
Orr became clearly frustrated with van Eeden’s continued inability to provide responses to her line of questioning, specifically when asking her what TAL meant when it authorised “desktop surveillance”.
“Miss van Eeden, it’s somewhat difficult when the person that TAL presents to deal with these case studies is unable to explain so many aspects of them,” Orr said.
